Dominica 2025 Trip Sign Up, DEV Bluegrass Dive Club

Trip:

Trip Status:*

Original

Revision

Name:*

Passport is required.
Please enter your passport information below:

Passport Number:

Home Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Best Phone #: (Include Area Code)

Email:

As Shown On Passport

Expiration Date: (type as shown on passport) Example: 17 Aug 2030

You are responsible for providing the proper travel identification documents to board the airline and/or to enter the country and reenter the US.

Room Type:

Occupancy:

Bedding Request

Rooming with:

Smoking:

No

Yes

Are booking as a Diver?

Diver

Non-Diver

Do you want Nitrox?

Yes

No

Do you need rental gear?

Yes

No

Comments or Additional Information:

Emergency Contact Name:

EContact's Phone #:

EContact's Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Relationship:

Include Area Code

By checking this box, I acknowledge that I have read and agree to the terms of the Bluegrass Dive Club's Waiver and Release of Liability Form. *

Yes

Initials (substitute signature) of person named in this reservation:*

Click the link below to read the waiver.

WAIVER AND RELEASE OF LIABILITY FORM

If the applicant named on this form is under the age of 18, this form will not be valid unless submitted by a Parent or someone assuming guardianship responsibility for applicant. Please enter name of Parent/Guardian submitting this form.

Guardian

The Bluegrass Dive Club does not require but recommends you secure a "Child Care Authorization" document for any non-custodial person under the age of 18 you plan to bring. Click ==> HERE for a PDF copy of this form.

The BGDC now accepts credit card payments. There will be a surcharge of 3.1% added to your charges. You will receive an email with your invoice for prompt payment.

By selecting the credit card payment option you are agreeing to the fee surcharge.

Cash or Check payments are not subject to the surcharge.

Payment Type Requested

Mail in Payment

Credit Card Payment

reCAPTCHA

Please be patient - Form may take a short time to process - You will see a confirmation page when complete. You will receive a confirmation of your submitted reservation at the email address given above for your records.